Journal article Open Access
Dr Areeba Afzal, Dr Noor u Sabah, Dr Anum Jamil
Background: Bleeding from the upper gastrointestinal tract is a medical emergency. Endoscopy is the preferred therapeutic and diagnostic procedure after the initial stabilization of the patient. However, the presence of blood, blood products, and other residues retained in the stomach is a major challenge for endoscopists during urgent endoscopy following acute upper gastrointestinal bleeding. Intravenous erythromycin before endoscopy improves the visualization of the gastric and duodenal mucosa in these patients. Since oral erythromycin is easier and more convenient to use,
Aim: The aim of our study is to evaluate the effect of oral erythromycin on the quality of endoscopy in patients with upper gastrointestinal bleeding.
Methods: This interventional study was conducted in the Medicine department of Lahore General Hospital for the period of six months from January 2021 to June 2021. Patients with clinical signs of acute upper GI bleeding within 12 hours were considered sequentially. Patients were randomized to an oral erythromycin suspension (500 mg) or a placebo three hours prior to endoscopy. The endoscopist performed all procedures with the same two-channel video endoscope. Endoscopic quality was the primary endpoint. Secondary endpoints included the need for a new endoscopy within 48 hours, endoscopic complications, treatment procedure with or without endoscopy, number of blood transfusions, and length of hospital stay.
Results: A total of 60 patients were enrolled in the study; 30 received erythromycin and 30 received placebo. Of these, 60% were male and 40% female. The mean age was 53.68 ± 16.64 years. The quality of endoscopy was significantly better in the erythromycin group (83.3%) compared to placebo (40%). Erythromycin did not reduce endoscopic time (15.53 vs 14.33 minutes in the placebo group; p = 0.216) and hospital stay (5.23 for erythromycin vs 5.40 days in the placebo group; p = 0.807). There was no statistically significant relationship between the use of erythromycin and the diagnosis of the cause of bleeding, the need for a new endoscopy, the number of blood transfusions and the number of endoscopic procedures.
Conclusion: Oral suspension of erythromycin before endoscopy in patients with acute upper gastrointestinal bleeding resulted in good quality of endoscopy in our study. The visualization of the gastric and duodenal mucosa has been significantly improved. However, this did not shorten the endoscopy or the hospital stay. There was also no significant difference in the number of revision endoscopies and blood transfusions.
Keywords: Erythromycin, Endoscopy, Placebo